ACCIDENT AND EMERGENCY DEPARTMENTS OF PUBLIC HOSPITALS (Increase in charges)

The following question stood in the name of Mr Yeo Guat Kwang -

Mr Yeo Guat Kwang: To ask the Minister for Health whether the upping of charges of the Accident and Emergency Departments (A&E) of hospitals is the only solution to prevent the indiscriminate use of such services.

Dr Lily Neo asked the Minister for Health the reasons behind the recent increase in charges for patients using the Accident and Emergency Departments (A&E) of public hospitals and whether he will consider other solutions to solve the problem of overcrowding at the A&E.

Mr Zainul Abidin Rasheed: Question No. 9, Sir.

The Minister for Health (Mr Yeo Cheow Tong): Sir, may I have your permission to answer Questions 9 and 10 together?

Mr Speaker: Yes.

Mr Yeo Cheow Tong: Sir, let me first emphasize that the role of the A&E departments is to cater to patients with injuries and emergency and life-threatening medical conditions. Consequently, they are staffed by specially trained doctors and nurses, both of whom are limited resources. Also, they are equipped with a wide range of diagnostic and treatment facilities to deal with potentially life-threatening conditions.

The A&E service is costly to operate because of the specialised and intensive medical and equipment resources involved. It costs on the average about $114 to treat each patient. Operating costs have increased by between 23% and 30% during the period 1993 to 1997 or between 5% and 6% a year. Yet the A&E fees have remained largely unchanged over these four years. The hospitals will need to recover at least part of the cost increases, especially if they are to continue adding more resources to cater for higher patient demands.

The total bill of a typical emergency patient before the fee revision is about $55. With the fee revision, a patient would pay a flat fee of between $50 and $70. This works out to an increase of between 3% and 5% a year, which is lower than the 5% to 6% annual increase in costs.

The A&E services are heavily subsidised. After the fee revision, the subsidy will still remain significant, at about 50%. Patients who cannot afford the A&E fees can seek financial assistance from the hospitals. No one needing emergency treatment will be turned away because of inability to pay.

Sir, let me touch on the prevention of indiscriminate use of A&E services. My Ministry had implemented several measures in the past to curb the increase in the number of non-emergency attendances at the A&E departments. These include educating the public on the proper use of A&E services, introduction of two-tier charging where non-emergency patients pay a higher attendance fee, and the establishment of walk-in clinics in the Singapore General Hospital and Tan Tock Seng Hospital.

However, in the last two to three years, attendances at A&E departments have been rising rapidly. Total attendances have increased by about 30% since 1994, or an average rate of 9% a year. What is of great concern is that the number of non-emergency cases rose by 38% during this same period. As a result, the median waiting time for emergency cases has gone up from 16 minutes to 26 minutes in 1996.

The data shows that a quarter of the A&E patients are not emergency cases. While already high, this figure is probably still understated, because many patients strongly object when the triaging staff at the A&E classify them as non-emergency cases. Part of the reason for their unhappiness at being declared a non-emergency case is that they then have to pay a higher consultation fee, and they are given lower priority in the treatment queue compared to the emergency cases.

Most of the non-emergency cases could have gone to the private GPs and polyclinics for treatment. About two-thirds of the non-emergency attendances occurred between 8.00 am and 9.00 pm when polyclinics and GP clinics are open for consultation. There are also 24-hour GP clinics and 24-hour outpatient clinics in the private hospitals. Non-emergency cases who feel unwell after the operating hours of polyclinics and GP clinics could either wait till the next day, since they are non-emergency, or see the doctors in the 24-hour clinics.

It is understandable that many non-emergency patients would prefer the A&E department instead because of their very comprehensive range of services. Also, with the fees having remained unchanged for four years, the gap between the A&E charges and that of private GPs has narrowed, making the A&E department an attractive alternative to the GPs.

However, it is important for the public to understand and appreciate that the A&E services are limited and crucial resources which are meant to cater to patients with truly emergency and life-threatening medical conditions. My Ministry and the hospitals will therefore continue to educate Singaporeans on what constitute non-emergency conditions, and on the proper use of the A&E departments. We will do this regularly through the mass media and will continue to seek the help of community and grassroots organisations to disseminate this information. The hospitals will also advise non-emergency cases that turn up at the A&E departments to seek treatment at nearby GP clinics or polyclinics, if these are open.

Dr Lily Neo (Kreta Ayer-Tanglin): May I ask the Minister where can the patients go but the A&E departments of the major hospitals when they fall ill in the middle of the night and are not the night clinics too few and far between to be an alternative facility to the A&E departments?

Mr Yeo Cheow Tong: Sir, as I have stated in my answer just now, if they are non-emergency cases, they can afford to wait to the next morning. If the pain or the condition is hurting them so much, and they are considered emergency cases, they can go to the A&E department. There is nothing to prevent them from doing that.

Dr Lily Neo: How is the patient going to know what constitutes an emergency and is it fair to penalise the patient for misjudging the severity of his illness?

Mr Yeo Cheow Tong: Based on that starting point, GP clinics should all close because every patient would then be very worried about his condition and he would go straight to the A&E clinic. Most patients and Singaporeans in general are quite careful and aware of what are emergency and non-emergency cases. 1.30 pm

Mr Speaker: Order. It is 1.30 pm. End of Question Time.

[Pursuant to Standing Order No. 21(3), Written Answers to Question Nos. 11, 13, 14, 16, 19 and 22 are reproduced in the section, "Oral Answers to Questions Not Reached" (Cols. 1787 - 1792). Question Nos. 12, 15, 17, 18, 20, 21 and 23 have been postponed to the next sitting of Parliament.]